Shoulder dislocation in patients older than 60 years of age

Abstract

Purpose:Recurrent anterior shoulder dislocation in elderly patients is a little studied condition. The goal of this paper is to clarify the role of associated injuries with respect to loss of function and recurrence of dislocation.Materials and Methods:We have conducted a retrospective, descriptive study on 29 patients older than 60 years at the moment they suffered their first dislocation episode. All patients were assessed clinically (Constant test) and by imaging testing (X-ray, MRI).Results:Nine (31.03%) out of 29 patients had a recurrent dislocation. Four of them required reconstructive surgery to maintain joint stability. Injury to the anterior support (anterior labrum, anterior glenoid rim) showed a statistically significant relation to the recurrence of dislocations. The occurrence or non-occurrence of a rotator cuff tear does have an impact on the shoulder function. The degree of rotator cuff involvement on the coronal plane does not significantly affect the shoulder’s functional outcome. The tear extension on the sagittal plane does cause impairment on the Constant test.Conclusions:Labrum and/or anterior glenoid involvement should be suspected in elderly patients presenting with recurrent shoulder dislocation. Recurrence is due to an injury in the anterior support or both (anterior and posterior), even though shoulder function gets impaired when a rotation cuff tear occurs with anterior extension on the sagittal plane. Evidence level: IV Case series.

What the patients (and their radiological imaging) tell us: Two peculiar stories...

“…They are predominantly anterior and inferior, out of which 95% follow trauma [2]. The incidence of atraumatic anteroinferior dislocations, such events during anaesthesia and recurrent dislocations among the elderly are small [3]. Positioning during anaesthesia, especially abduction and external rotation of the upper limb, predisposes to anterior dislocations and muscle relaxation may play a synergistic role.…”

The Trillat Procedure for Anterior Glenohumeral Instability

“…The greater prevalence of preexisting rotator cuff degeneration in older adults is believed to result in abnormal dynamic constraint of the glenohumeral joint, predisposing to shoulder instability after low energy trauma 23 . Recurrence of AGI after a first episode has been reported in 0% to 33% of cases in patients older than 40 years 22,[24][25][26] .…”

Conduite à tenir devant une première luxation gléno-humérale traumatique antérieure récente

“…Il faut donc la rechercher soigneusement. Les lésions de la coiffe sont très variables, mais on sait qu'après une luxation d'épaule, l'extension antérieure d'une rupture vers le subscapularis est de très mauvais pronostic [22]. Quoi qu'il en soit, devant une épaule rééduquée qui reste impotente, sans cause neurologique, une exploration de la coiffe des rotateurs est indiquée, surtout après 40 ans.…”